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HINDOOSTAN MILLS LTD.

SUPPLY PARTNER REGISTRATION FORM (DOMESTIC SUPPLY)

Form Issued for * Head Office ECK Composite_R&D

Karad Composite_Karad

Name of Vendor * : VINAYAK TEXTILES

Office Address* : Shop/Flat Number * : 635, Krishna Chowk, M.J. Market, Kalbadevi

Premises Bldg /Mall/Industries * : MULJI JETHA MARKET, KALBADEVI

Street * : KALBADEVI

Pin Code * : 400 002 City * : Mumbai State * : Maharashtra

Works :

Warehouse Address * : Dhabolkar Wadi, Kalbadevi, Mumbai

Pin Code * : 400 002 State* : Maharashtra

Tel. * : 9892408879 Works :

Fax : Works :

Email Address * : siddharth.oza14@gmail.com Email Address *: siddharth.oza14@gmail.com

Contact Person * : Name & Designation Siddharth Oza Mobile No *: 9892408879

Date Of Establishment :

Supply From : Office Works Warehouse

Website :

Products to be supplied to Raw Material Stores Job Workers .

Hindoostan Mills Ltd.
Fixed Assets

Others

Please specify details of products

to be supplied : *

" * " Indicates Mandatory Fields.

* Kindly enclose extra sheets wherever required
GENERAL / PRODUCT INFORMATION
Type of Company* Proprietorship Partnership Private Ltd. Public ltd. Other

Type of Industry * Small Scale Large Scale Government Contractor

Vendor Type* Manufacturer Trader Contractor Service Accessories

COMMERCIAL INFORMATION
Particulars Regn Number Eff. Date
Local Sales Tax */ VAT*
Central Sales Tax *
Excise Registration No. *
PAN *
Service Tax No.*
Whether Registered in Micro Small &
Medium Enterprises Act 2006 *
(Pls send us confirmation mail)
Accounting Info *
Terms of Payment *
Terms of Delivery

NEFT /RTGS Details *

Bank Name
Bank Account No.
IFSC Code

ANY OTHER REMARKS

Enclosures

Date and Place Signature and Seal of The Vendor

FOR OFFICE USE ONLY (Authorisation details)

PREPARED BY (Name) * HOD'S SIGNATURE *

________________ ________________
FINANCE DEPARTMENT *

" * " Indicates Mandatory Fields.

 CHECKLIST

1* Indicates Mandatory Field

a Name of the Vendor

b Office Address
c Pin Code
d State
e Warehouse Address
f Pin Code
g Tel.
h Email Address
i Central Sales Tax / VAT
j Local Sales Tax / VAT
k PAN
l Service Tax No.
m Excise Registration No.
n Whether Registered in Micro, Small & Medium Enterprises Act 2006
o Terms of Payment
p NEFT/RTGS details of Vendors
q HODS Signature
r Finance Departments Signature
s Agreement if any

2 Supporting required for the following :

a Certificate for Central Sales Tax No
b Certificate of VAT
c PAN
d Certificate for Service tax No
e Certificate for Micro, Small & Medium Enterprises Act 2006